How to fix a Posterior Pelvic Tilt

… Do you have a Posterior pelvic tilt? 

Posterior pelvic tilt


Article summary:


// What is a Posterior pelvic tilt?

A Posterior pelvic tilt is where the pelvis is rotated backwards from the ideal neutral position.

This causes a rounding of the natural curve in the lower back. (… also referred to as a loss of lumbar lordosis)

Note: If you would like to know more about the ideal pelvis position, check out this post: The correct pelvis position in sitting.

 

// Why is having a Posterior pelvic tilt is an issue?

Having a posterior pelvic tilt WILL drastically effect the rest of your posture (even up into the upper back and neck!)

It is vital that you address your Posterior pelvic tilt as soon as possible. It may just be the one reason why you have so much pain and tightness in your body.

When you have a Posterior pelvic tilt, there will be an associated flattening/curving of the lower back.

So what? Why is this an issue?

You need your curve! It helps distribute the forces in your lower back more efficiently.

discbulge

Without a natural curve in your lower back, you are at a higher risk of developing painful injuries such as disc bulges, nerve issues and muscular strains (… just to name a few) in your lumbar spine.

 

// When do people experience a Posterior pelvic tilt?

From what I’ve seen in my patients at the clinic, it is more common to have a Posterior pelvic tilt whilst sitting, bending over, squatting and/or occasionally standing.

a) Sitting:

ppt in sitting

Do you slouch in your chair? If you do, then you probably have a Posterior pelvic tilt whilst sitting.

 

b) Squatting:

pptsquat

If your lower back tends to round whilst doing a deep squat, then your pelvis is most likely rotating backwards. This is referred to as the “butt wink”.

 

c) Bending over:

ppt bending

Think about the times when you are picking something from the floor, tying your shoe lace or even putting on your underwear. Are you rounding your lower back? If so, you have a Posterior pelvic tilt!

 

d) Standing:

sway back alignment

If you have a sway back posture or flat back syndrome, then you likely have a Posterior pelvic tilt as well.

// What causes the Posterior pelvic tilt?

If I were to blame just one thing, I would say: Sitting.

You are either sitting too much or sitting with bad posture.

And if I were to guess…. I would say that you are probably doing both!

 

 

// What’s happening at the muscular level?

Excessive sitting causes certain muscles that control the position of the pelvis to get tight/overactive and/or weak/inhibited.

As a result, there is an imbalance of the forces around the pelvis region causing a net force to tilt backwards (posterior pelvic tilt).

ppt

Tight/overactive muscles:

  • Hamstring
  • Gluteal group
  • Abdominal

Weak/Elongated:

  • Hip flexor group
  • Lumbar spine erector group

** These are the muscles that we will be addressing in the exercises as mentioned below.

// How to tell if you have a Posterior pelvic tilt

neutralppt stand

In standing, place one finger on your pointy hip bone at the front, and the other on your pointy bone at the back. (check out the picture above for the points.)

  • If you have a Posterior pelvic tilt, the finger at the front of your hip bone will be significantly higher in comparison to the finger on the pointy bone at the back.
  • Note: Everyone has different shaped and sized “pointy bones”. This is just a general guideline to quickly determine if you have posterior pelvic tilt or not.

In bending over/squatting or sitting, pay attention to your lower back. If at anytime the lower back curves forward, then you most likely will have a backward tilted pelvis.


Do this:

L sit

You should be able to sit on the ground with your back up against the wall whilst keeping your legs completely straight. (… without curving your lower back)

If you can’t, it is likely that you will have a posterior pelvic tilt!


How to fix a Posterior pelvic tilt

Let’s fix your Posterior pelvic tilt!

Here are the steps:

  1. Stretch/Release the tight/overactive muscles
  2. Activate the inhibited muscles
  3. Strengthen the weak muscles
  4. Open up your hips
  5. Train your brain to keep the pelvis in the neutral position

1. Stretch and Release

It is vital to stretch/release the muscles responsible for holding the pelvis in a posterior tilt.

(… the hamstring and abdominal muscles are usually the culprits responsible.)

 

 

Stretches

// Hamstring

hamstring stretches

a) Upper hamstring:

Instructions:

  • Whilst standing, place a slightly bent knee in front of you. (see above)
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the upper portion of your hamstrings.
  • Hold for 60 seconds. Alternate legs.

b) Lower hamstring:

Instructions:

  • Whilst standing, place a straight knee in front of you.
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the mid/lower portion of your hamstrings.
  • Hold for 60 seconds. Alternate legs.

 

// Gluteal muscle

glute stretch

Instructions:

  • Lie on your back with your knees bent and feet on the floor.
  • Place your left ankle on the right knee.
  • Grab your right knee and pull towards your chest.
  • Aim to feel a stretch on your left glute.
  • Ensure that you arch your lower back to increase the stretch.
  • Hold for 60 seconds.
  • Alternate sides.

 

// Abdominal stretch

abdominal stretch

Instructions:

  • Lie on your stomach.
  • Place hands on floor directly under shoulders.
  • Straighten your elbows.
  • Arch backwards. (Note: Be careful if you have lower back issues)
  • Aim to feel a stretch across your abdominal region.
  • You can rotate from side to side to emphasise the stretch to certain areas.
  • Breathe and expand your stomach as you stretch.
  • Hold for 60 seconds.

 

Releases:

// Hamstring

hamstring release 

Instructions:

  • Place your hamstrings on top of a massage ball. (see above)
  • Use your body weight to apply pressure onto your hamstrings.
  • Make sure to cover the entire hamstring muscle
  • Do this for 60 seconds.
  • Alternate sides.

// Gluteal

glute release

Instructions:

  • Place your gluteals on top of a massage ball. (see above)
  • Use your body weight to apply pressure onto your gluteal muscles.
  • Make sure to cover the entire muscle.
  • Do this for 60 seconds.
  • Alternate sides.

// Abdominal

abdominal release

Instructions:

  • Lie on your stomach.
  • Place a massage ball under your abdominal region
  • Gently circulate your body weight on top of the ball.
  • Be careful not to apply too much pressure. (Do not squash your organs!)
  • Use deep breaths to help relax your muscles.
  • Hold for 60 seconds.

2. Activate the inhibited muscles

The muscles that are responsible for reversing the Posterior pelvic tilt are not being recruited.

Wake up your sleeping muscles! 

You can not strengthen muscles that are not activating in the first place.

// Sitting knee lifts

This is to activate the hip flexor muscles.

sitting hip flexion

Instructions:

  • Sit up right.
  • Whilst keep your back still, bring one knee up towards the roof.
  • Hold for 5 seconds.
  • You can progress the exercise by using resistance bands.
  • Repeat on other side.
  • Alternate for 30 repetitions each.

// Superman

This is to activate the lower back muscles.

superman

Instructions:

  • Lie on your stomach.
  • Stretch out your arms in front of you.
  • Lift your upper body and legs off the floor.
  • Hold for 5-10 seconds.
  • Repeat 30 times.

 

 

3. Strengthen the weak muscles

 

// Pelvic tilt (in 4 pt kneel)

tilt exercise

Instructions:

  • Assume 4 point kneel position. (see above)
  • Arch your lower back as you tilt your pelvis forward.
  • Hold for 10 seconds.
  • Return to neutral spine.
  • Repeat 30 times.

 

// Pelvic tilts (in sitting)

tilt in sitting

Instructions:

  • Sit on an exercise ball or a chair.
  • Sit upright. Think long and tall throughout the spine.
  • Proceed to tilt the pelvis forward.
  • Hold for 10 seconds. Relax
  • Repeat 30 times.

// Sitting pelvic tilts (with resistance band)

Instructions:

  • Place a resistance band around your waist. Tie other end to a stationary object behind you.
  • Sit on an exercise ball or chair.
  • Sit upright.
  • Proceed to tilt the pelvis forward.
  • Hold for 10 seconds.
  • Repeat 30 times.

// Core strengthening (4 point kneeling with hip flexion)

4 pt kneel hip flexion

Instructions:

  • Assume the position as seen above.
  • Make sure that your pelvis is in a neutral position.
  • Engage your core muscles.
    • Think about a) drawing your belly button in and b) gently tensing your abdominal muscles.
  • Bring your knee up to your chest whilst maintaining a slight arch in your lower back.
  • Hold for 5 seconds. Repeat 20 times.
  • Alternate legs.

4. Open up your hips

Tight hip joints can make it very difficult to maintain a neutral pelvic alignment. If you are not flexible, this section of the article is for you!

 

// Posterior capsule stretch

posterior capsule release

Instructions:

  • Assume position as seen above.
  • Make sure your knee is directly underneath your hip joint.
  • Maintain the lower back arch throughout movement.
  • Lean back into the stretch.
  • Feel a deep stretch in the back of your hip.
  • Hold for 20 seconds. Relax.
  • Repeat 5 times.

// Joint mobilisation

Video from Generation Care Centre.

Instructions:

  • Place a resistance band around your hip joint.
  • Anchor the other end of the band to a stationary object.
  • Lie down on your back.
  • Bring and hold your knee towards your chest.
  • Move away from the anchor point to adjust the tension on the band.
  • Hold for 60 seconds. Repeat 10 times.
  • Alternate legs.

// Butterfly stretch

butterfly stretch

Instructions:

  • Sit on the floor with your back supported against a wall behind you.
  • Bring your feet together.
  • Let your knees drop to the ground.
  • Hold for 30 seconds.
  • Repeat 3 times.

5. Maintain a neutral pelvis in functional positions

You can perform all the above exercises, BUT… if you do not apply it to the positions you adopt for most of the day, then your posterior pelvic tilt will continue to exist.

But first – you need to know how to find the neutral position of the pelvis. Check out this post here to find out.

Since you have had your Posterior pelvic tilt for many years now, your body is going to try and go back to it as a default setting. You need to resist that!


Maintain a neutral pelvis throughout the exercises as below.

// How sit properly

ffr

“Sit on your sit bones”

Do this. Whilst sitting, place your hand underneath your bottom and locate a pointy bone. Did you find them?

That is your sit bone.

To position your pelvis properly, aim to sit directly on top of the sit bones.

The problem I see evident in most of my patients is that they tend to let their tail bone tuck underneath and sit behind the sit bones.

 

// Hip hinge (aka bending forward)

bow

Instructions:

  • From a standing position, hinge forward from the hips.
  • Make sure to keep your back completely straight.
  • Only bend forward as far as you can maintain neutral pelvis.
  • Repeat 20 times.
  • To progress: Hold a weight in your hands

// Squatting

Instructions:

  • Stand sideways to a mirror so that you can monitor the curvature of your spine.
  • Practice squatting as deep as you can go without rounding of your lower back.
  • Maintain neutral pelvis.
  • Repeat 20 times.

 

// Plank

Plank

Instructions:

  • Get into the plank position. (see above)
  • Make sure to maintain neutral spine and pelvis.
  • Hold for 30 seconds.
  • Repeat 5 times.

 

 

 


// BONUS tips

Use a lumbar support in sitting: This will maintain the natural lumbar curve and prevent your pelvis from slouching.

Adjust your chair higher: If you have large thighs (… and/or a large abdominal area), adjust your seat higher so that there is minimal contact between your abdominals and upper leg. Consider getting a kneeling chair.

Bend your knees when lifting objects from the floor: This will help keep your back and pelvis in a neutral position.

Avoid reverse curls: Abdominal crunches will tend to encourage a posterior pelvic tilt.

Do NOT butt/abdominal gripping: This basically means to avoid tensing your glutes and/or abdominal muscles excessively.

Avoid sitting on soft sofas: There is no pelvis support on these! Your pelvis will slouch into a posterior pelvic tilt.

Driving: Adjust your car seat to ensure you sit with good posture.


 

See how you go with these exercises to resolve your posterior pelvic tilt.

Persistence is the key!

If you have any questions, please feel free to leave me a message in the comments section below!

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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30 thoughts on “How to fix a Posterior Pelvic Tilt

  1. Mark, I just wanted to thank you for your incredibly valuable advice. I have just started the exercises and it has already alleviated much of my pain and stiffness. I am so grateful to you for your efforts. Thank you, Ryan W

  2. Is it possible to have weak and tight hip flexors with a posterior pelvic tilt? My abdominals are so tense and they cannot relax…

    1. Hey Chris,

      Most definitely!

      Tight muscles can actually be weak muscles. You may want to strengthen then, but do so with a) your pelvis in neutral and b) in balance with all the other surrounding muscles.

      The tightness you feel in your hip flexors is what we refer as the muscles being Eccentrically Loaded.

      Think about a rubber band. If you stretch it out, there is now a lot of TENSION in the band. Similarly like your hip flexors, Although it is stretched out (not tight), you can still feel the sensation of the muscles feeling tight.

      Hope this answers your question.

      Mark

  3. Thank you for these exercises! My back is very flat – years sitting working at a desk, I think. How often and for how long (ie years?) will I need to do these before my lower curve returns? 🙂

  4. Hi Mark!

    Thank you for this article. It is a great help. My question is: I have a patient who sits all day due to MS. His PPT is extremely advanced. What advice would toy give to begin to see significant improvements in his lordosis so that he can begin to maintain better posture.
    Thanks!

    1. Hey Bonita,

      Cheers for your questions!

      Here are a few additional ideas from the top of my head:

      – Make sure that the chair is appropriately adjusted to your patient’s measurements.
      – Use a lumbar support for the lower back to increase lumbar lordosis.
      – Ensure that your patient sits all the back into the chair.
      – Use a seat wedge or slightly tilt the chair backwards to help open up the hip angle.

      Is he able to do any of the above exercises?

      Mark

  5. Hey Mark,

    Ive been working on your poked neck and rounded shoulder routine for the past couple of weeks and its been great so far. I have an impinged shoulder and im definitely experiencing less pain in general. I notice that I definitely have a posterior pelvic tilt as well, especially when sitting which I read can affect my upper back and shoulder pain. While getting the impingement fixed is first priority, how would you rank what the most important fix between the neck shoulders and pelvis? Im trying to do it all every day, its just tough, especially if I throw in the workout for the PPT.

    Thanks for sharing everything on your site, much appreciated.

    1. Hi Brent,

      It’s all connected!

      If you want specific exercises for your shoulder impingement, check out this post!

      In terms of what takes priority, it really depends!. But if you want a general order of priority, I would focus on fixing the pelvis first.

      Why? It is your foundation. (Think of a stack of bricks… If the bottom piece is not placed properly, everything on top (even if stacked nicely) will be off balance.

      However – if you experience pain in the neck/shoulders, it is a good idea to address these areas first with the neck/shoulder specific exercises to reduce your symptoms.

      There are definitely a lot of exercises to do, but as you get better, you can start to omit some of them. It’s all about building momentum in the initial stages.

        Hope this helps!

        Mark

  6. Hi, Mark,

    These instructions are very helpful, thank you so much. Some of them are very painful; would you recommend investing in chiropractics, physical therapy, massage therapy, or a combination to treat advanced PPT?

    Thank you.

    1. Hey there Mary,

      Thanks for visiting the blog.

      Which exercises in particular are painful? We might need to change the way that you are performing them so that it is not flaring up any symptoms.

      To be honest, all those health practitioners that you mentioned are great at addressing your PPT.

      You just need to make sure that you find the right practitioner who is familiar with dealing with this type of issue.

      Mark

      1. Thank you for creating the blog, and your quick response! To be frank, even holding my pelvis in a neural position is somewhat painful – as all of my afflicted muscle groups are so weak/tight – so almost all of the stretches are difficult to maintain in the correct position. I think the fascia is very dense and I don’t have a massage ball for the releases – is there a substitute you suggest?

        The reason I asked about specialists is I feel I would benefit from having a professional coach me and ensure I am keeping correct posture throughout treatment and recovery.

        I have suffered from this malady since an injury to my sacrum at the age of 12 from an ATV accident, and was only recently diagnosed at 26; it is so truly amazing to know that it is possible to treat this anatomical issue which has been digressing steadily throughout my life without treatment.

        One last, hopefully quick question (and thank you so much for your time and professional advice) – if I were to take an over the counter pain medication to combat the constant soreness, would you be more inclined to recommend ibuprofen, advil, or tylenol while attempting this physical therapy at least 2x/day?

        Thank you so much! I really appreciate it.

        Mary

  7. Thank you so much for sharing your knowledge with us, this helps immensly. I`m a 25 year old man, in good shape, but i obviously have PPT. I go to the gym regularly, and my question is, should i stop squatting? Also, my glutes are very tight, but also very weak, does that make sense? I`m also having trouble with my hip flexors, they often pop/hurt when squatting and even when im just straightening my leg from a lying position.

    Once again, thank you for the article, hope you reply!

    1. Hey Marko,

      If you stand with a Posterior Pelvic Tilt, then it is likely your hip flexors are constantly being stretched. This can make them very weak and may explain why you have difficulty with lifting up a straight leg from a lying down position.

      Focus on restoring normal neutral pelvis, and strengthening your hip flexors.

      I am a big fan of squats, and I prescribe them to many of my patients. However- if you squat with the incorrect technique, then this is where you might want to reconsider doing squats until you address your underlying issues.

      You might need to have someone have a look at your squat technique and go from there.

      Hope this helps!

      Mark

      1. Hi, I am 63 yo. I have a posterior pelvic tilt. I can’t lift my left
        leg straight more than 45 degrees. You think the exercises will
        help. This is very painful. This is from bad posture, I hope it’s
        not to late for me. Any help will be appreciated. Thanks,
        Lovelace

        1. Hi Lovelace,

          There are quite a few reasons as to why your Left SLR is limited.

          Disc pathology
          Tight hamstring
          Overly stretched hamstring
          Nerve tension
          Myofascial tightness
          Incorrect pelvis position
          … just to name a few

          For your particular situation… what exactly is painful? Where does it hurt, What does it feel like? How does it compare with the Right side?

          But yes, having a posterior pelvic tilt can lead to all of the above mentioned. So working on that will definitely help.

          Looking forward to your reply.

          Mark

  8. Hi, I am 63 yo. I have a posterior pelvic tilt and my left leg I
    can’t lift it straight more than 45 degrees. You think these exercises
    will work on me. I would appreciate any suggestions. What could
    I do for the leg. Thanks, Lovelace Boudreaux

  9. Hello, Mark. First of all, thank you so much for the wonderful blog about fixing posture. I have been practicing the stretches you posted about and it has helped me immensely. I have one question though, is there a way to correct bow legs? Some say it can be fixed by exercise but some say it can only be fixed by surgery. I’ve been self-conscious about my bowlegs for many years now and tried to find a cure for it. I know there’s a lot of info on the internet, but most of them are scam. I am asking you because you seem most reliable when it comes to this subject. Thank you and have a happy new year.

    1. Hi Orange Jello,

      If your bow legs are STRUCTURAL… meaning if your bones are shaped this way, then it can not be fixed.

      However, if it is due to positioning of your pelvis/hips/knee/ankle, then it can definitely be improved.

      Were you born with it?

      Mark

      1. I don’t know for sure. I do believe I was born with it. I heard that many infants were born with bowlegs, which is normal, but their legs straighten as they grow up?? But I guess my legs didn’t straighten for some reason. I know that it isn’t rickets. Do you think the exercises can improve my legs to appear less bow-leggy even if it’s structural? I’m still going to do the exercises to fix my posterior pelvic tilt.

        1. If your bones are shaped like that, there is not too much we can do besides strengthening your muscles in that position.

          How’s your foot posture? Do you have high arches?

          Mark

          1. I think my feet are a little bit to the high arch side. My shoes tend to wear on the heels. I never had foot problems though.

  10. Mark,
    Thank you so much for your information as I feel my posture improving so so much. Just a question, do you feel that PPT can be related to love handles? To where poor posture “redirects” fat to be stored in lower back as to the butt?

    1. Hi Danny,

      Thanks for commenting 🙂

      Posterior Pelvic tilt can give the illusion that there is excess fat around the waist line.

      Usually you can see fat roll imprints on the stomach region after sitting in bad posture for a long period of time.

      But ultimately, you would want to try and lower total body fat% to get rid of those love handles.

      Mark

  11. I had 6 pack abs but after having ppt it is seeming that i have become fat (only for my stomach).I have to now take my stomach in to make my abs come up.Is it possible for fit people to have ppt? I dont know how worse is my ppt so can i send the photo

  12. 57 yo male, with posterior pelvic tilt (PPT). Tall, skinny, athletic years ago, but seriously lethargic, and sitting poorly for last 20 years . Currently carrying 20 extra lbs around waist (6’2″ 195lbs). Am working on getting rid of the tilt, and adding “core” strength heading into older age. 20 years is a lot to reverse.

    Q. when I decide to rest, is it best to sit in recliner, or flat (in a bed)?

    Q. What is the best sleeping position?

    Q. I still work at a computer all day. Is it best to create a taller “standing desk”, sit on a rubber ball (if so, what size, inflation?), or use a knee chair (if so, what dimensions?)? I may use two desks, one to stand at as long as possible, then a sitting desk after I get tired. Your thoughts?

    Q. Is there a proper position that I can use in a reclining chair with laptop in my lap that will help (PPT)?

    Q. I’m trying to get ideas on how to apply correct posture to all parts of my life, not just gym time. I have room in my office to excercise during work hours. Am playing racquetball, tennis, ping pong, and golf, but sitting otherwise. I’m thinking a couple of hours at the gym every other day won’t do it.

    Your thought, please.

    1. Hi Wallace,

      Thanks for your questions.

      Q. when I decide to rest, is it best to sit in recliner, or flat (in a bed)?
      It doesn’t really matter which one you rest in. However – if you want to avoid tilting your pelvis, then I would say lie flat on your bed. Please note that PPT is not necessarily a bad thing unless it is excessive and stuck in that position for a long period of time.

      Q. What is the best sleeping position?
      I have written a post on this which can find right here.

      Q. I still work at a computer all day. Is it best to create a taller “standing desk”, sit on a rubber ball (if so, what size, inflation?), or use a knee chair (if so, what dimensions?)? I may use two desks, one to stand at as long as possible, then a sitting desk after I get tired. Your thoughts?
      The best option is to change positions

        as many times as you can

      . Being stuck in any position (including standing) places too much stress to the body. I use 3 different chairs at home myself.

      Q. Is there a proper position that I can use in a reclining chair with laptop in my lap that will help (PPT)?
      Not that I can think of, unless you have a reclining chair specifically made for laptop use where there is a docking station.

      Q. I’m trying to get ideas on how to apply correct posture to all parts of my life, not just gym time. I have room in my office to excercise during work hours. Am playing racquetball, tennis, ping pong, and golf, but sitting otherwise. I’m thinking a couple of hours at the gym every other day won’t do it.

      In the ideal world, it is better to have as many hours (or more) being active then you are sitting down. If you can focus on postural exercises several times throughout the day whilst you are working, that would be a more practical goal.

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